All issues
Volume 75 (2023)
- Issue 4 Pages 428-
- Issue 3 Pages 203-
- Issue 2 Pages 117-
- Issue 1 Pages 1-
Volume 75, Issue 3
ADVANCES IN OBSTETRICS AND GYNECOLOGY Vol.75 No.3
Displaying 1-29 of 29 articles from this issue
- |<
- <
- 1
- >
- >|
ORIGINAL
-
Naoya SHIGETA, Yuki MATSUMURA, Mie TANAKA, Mariko TANIGUCHI, Etsuko NA ...2023 Volume 75 Issue 3 Pages 203-211
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSThe dinoprostone vaginal insert is a cervical ripening treatment for the prevention of post-term birth and the induction of labor due to maternal complications. The dinoprostone vaginal insert (synthetic prostaglandin E2 analogue), which is a pharmacological technique, became available in Japan from April 2020. We report the results of using the dinoprostone vaginal insert in 73patients (dinoprostone group) in our hospital from April 2020 to December 2021. We propose the standard of selective use of dinoprostone vaginal insert. The rate of successful cervical ripening (vaginal delivery within 12 hours or a Bishop score > seven points) was 39.7%. Forty-six (76.7%) primiparous patients and 100% parous patients achieved vaginal delivery. We compared the results of cervical ripening by mechanical methods in 103 patients in our hospitalfrom April 2019 to march 2020 (conventional group) with dinoprostone group. The rate of vaginal delivery of primiparous patients without ruptured membranes of dinoprostone group was higher than conventional group although the rate was not statistically significant (dinoprostone group vs conventional group; 74.5% : 65.7%, p=0.46). The rate of vaginal delivery was 100% in parous patients in both groups. Time from induction to delivery was significantly shorter in conventional group than dinoprostone group (p<0.05). The onset of labor by dinoprostone vaginal insert was extracted as significant factor of achieved vaginal delivery with using dinoprostone vaginal insert by comparing the results of vaginal cases between cesarean cases. In the most successful cervical ripening cases, the duration of using dinoprostone vaginal insert was under eight hours These results suggested that selective application of dinoprostone vaginal insert for primiparous patents without ruptured membranes for successful induction of labor and we propose the using dinopstone vaginal insert at least eight hours for parous patients in the admission day of induction of labor for cervical ripening. [Adv Obstet Gynecol, 75(3) : 203-211, 2023 (R5.8)]View full abstractDownload PDF (1427K) -
Hiroko HAMADA, Morifumi HAMADDA2023 Volume 75 Issue 3 Pages 212-220
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSSince 2019, we have treated 26 hospitalized patients with threatened premature birth using a cervical pessary (Arabin pessary). The cervical pessary, made of silicone, is soft; hence, patients rarely complain of pain after its placement. It is minimally invasive and easy to put on and take off. It cannot be used on patients with an intrauterine infection, premature rupture of membranes, already painful regular contractions of the uterus, or vaginal bleeding. At our hospital, patients with a tocolysis index of three points or higher are admitted for treatment. We compared 45 patients who were hospitalized and treated for threatened premature birth from 2016 to 2018 with 26 patients who were hospitalized and used a cervical pessary from 2019 to 2021. Patients with a tocolysis index of five points or more at the time of consultation were judged to be inoperable and provided with maternal transport, and they were excluded from the comparative analysis. There were five maternal transport cases due to threatened premature birth from 2016 to 2018 and four from 2019 to 2021. Seven patients from 2016 to 2018 and seven from 2019 to 2021 were between 34 and 36 weeks of gestation at presentation, for whom tocolysis was impossible but who were delivered at our hospital. These patients were also excluded from the comparative analysis. No significant differences were observed between the two groups in maternal age, tocolysis index, cervical length on admission, number of gestational weeks at delivery, birth weight, Apgar score, umbilical artery blood pH, and volume of blood loss at delivery. The duration of hospital stay was 29.78±5.49 days in the non-cervical pessary group and 9.04±2.88 days in the cervical pessary group, showing a large difference. This study found that placement of a cervical pessary for patients with threatened premature birth resulted in a significant reduction in the length of their hospital stay. Almost all patients experienced an increase in the amount of vaginal fluor after discharge, but early discharge was possible. After discharge, the patients were given oral ritodrine and periodical administration of antibiotic vaginal tablets until 36 weeks of gestation, under the instruction of relative bed rest. [Adv Obstet Gynecol, 75(3) : 212-220, 2023 (R5.8)]View full abstractDownload PDF (3690K) -
Shuhei EBISU, Ritsuko YASUDA, Takahiro WATANABE, Shion TOKUNAGA, Mich ...2023 Volume 75 Issue 3 Pages 221-229
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSIn ovarian torsion, the intraoperative findings of ovarian necrosis are used to determine whether ovarian preservation is possible and the optimal surgical methods for treating the condition. However, the discrepancy between gross necrosis findings and pathologic necrosis diagnosis is often problematic for this selection process. Therefore, if pathologic necrosis can be predicted by preoperative examination, the accuracy of pathologic necrosis diagnosis can be further improved, and surgical methods that contribute to better patient outcomes can be selected. In the present study, we examined the association between preoperative CT scan values and pathologic necrosis and hemorrhage, as well as between intraoperative findings of gross necrosis and pathologic necrosis. The results showed that preoperative CT values did not predict pathologic necrosis, but pathologic hemorrhage was observed in 91% of cases with gross necrosis and pathologic necrosis was observed in only 29% of these cases. These results suggest the possibility of further ovarian preservation in the selection of surgical methods of treating ovarian torsion. [Adv Obstet Gynesol, 75(1) : 221-229, 2023 (R5.8)]View full abstractDownload PDF (2191K) -
Kaoru NAKAGAWA, Masayo UKITA, Yoshitsugu CHIGUSA, Mana TAKI, Koji ...2023 Volume 75 Issue 3 Pages 230-237
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSObjective : To examine the prognostic impact of different treatment intensities in older patients with endometrial cancer. Methods : Clinical data of patients aged over 70 years with endometrial cancer who underwent initial treatment between 2009 and 2018 were retrospectively reviewed. Standard treatment (ST) was defined as surgery with or without chemotherapy. Reduced treatment (RT) was defined as limited surgery or conversion to radiotherapy, or omission of chemotherapy. Results : Among 84 patients, 40 received ST and 44 opted for RT. There was no difference in the distribution of cancer stage, or histologic type. However, patients receiving RT were older (p < 0.0001) and had worse performance status (ECOG) (p = 0.003) compared to those receiving ST. For early-stage cancer, there was no difference in prognosis between treatment intensities, whereas for advanced cancer with high grade histology, the overall survival rate was significantly worse with RT (p = 0.03). Conclusion : This study revealed that about half of the elderly patients with endometrial cancer were treated with some form of reduced treatment. In early-stage cancer, reduced treatment intensity might have little impact on prognosis regardless of the histological grade. [Adv Obstet Gynecol, 75(3) : 241-248, 2023 (R5.8)]View full abstractDownload PDF (1470K) -
Ryoko MINEKAWA, Takanori YOSHIDA, Hiromi OGATA, Seiji OGATA2023 Volume 75 Issue 3 Pages 238-248
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSTubal pathology contributes to 25-30% of all infertility among women. Hysterosalpingo-foam sonography (HyFoSy) is used in our clinic as one of the initial workups, however some women may hesitate to undergo due to anxiety or discomfort. This questionnaire-based survey was undertaken to assess patients’ pain perception during and after HyFoSy and compare with self-anticipated pain before examinations. Numerical rating scale (NRS), which describes zero = no pain and 10 = possible worst pain respectively, was used to measure pain intensity. Self-anticipated pain scores were significantly higher than actual pain. Patients who experienced moderate to severe pain (NRS=four or more) during examinations revealed higher number in medical history of chlamydia infection. The difference in pain perception was statistically significant during procedure when patients were grouped by tubal patency, however no difference was seen after examinations. When patients were assigned into three groups according to their pain tolerance, the group with lower pain tolerance showed significant difference between self-anticipated and actual pain during procedure. Out of 62 cases with assistance of nurses, 57 patients (92%) reported it as helpful. These results suggested that sufficient pre-test information, preparation of analgesics and psychological support are key factors for women to overcome pain and anxiety. [Adv Obstet Gynecol, 75(3) : 230-240, 2023 (R5.8)]View full abstractDownload PDF (1760K)
CASE REPORT
-
Oriha AKASAKA, Ryuta MIYAKE, Miho OKAMOTO, Shunsuke ONISHI, Mayuko ...2023 Volume 75 Issue 3 Pages 249-254
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSIn the present case, an epignathus was suspected in one of a pair of dichorionic diamniotic twins at 22 weeks of gestation. The tumor grew bigger and became complicated with polyhydramnios from 30 weeks of gestation. By the case conference held by obstetrics, anesthesiologist, neonatologist and pediatric surgeon, elective cesarean section was performed at 34 weeks of gestation. Despite the intensive treatment, the baby died due to airway management difficulty. The histopathological findings of the mass was met for encephalocele rather than epignathus. There are many reports that if the big mass in front of the mouth that obstruct airway is removed, it might not interfere with the subsequent neonatal growth and development. However, as in this case, the tumor may be suspected as an encephalocele by a histopathological examination, and the neurologic prognosis of the newborn may be poor even if surgically desected. [Adv Obstet Gynecol, 75(3) : 249-254, 2023 (R5.8)]View full abstractDownload PDF (3532K) -
Moyu MATSUI, Toru KATO, Kohei NAKAGAWA, Kazuya TAKEDA, Ayano YAMA ...2023 Volume 75 Issue 3 Pages 255-261
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSAsherman’s syndrome is caused by intrauterine manipulation, and can also occur after uterine compression suturing (UCS) for flaccid bleeding. However, there are few reports on this. We report a case of Asherman’s syndrome diagnosed after UCS that was successfully treated with adhesiolysis using a microhard hysteroscope in an outpatient setting. A 31-year-old patient had two live births and one spontaneous miscarriage. The sclera exhibited blue discoloration, and she had decreased bone density, wide range of motion, and a history of recurrent joint dislocation. Her family history included a sister with congenital dislocation of the hip joint, and suspected hereditary connective tissue diseases such as Marfan syndrome. An elective cesarean section was performed at 38 weeks and four days of gestation. Postpartum flaccid bleeding was observed; three longitudinal sutures for uterine compression were performed from the anterior and posterior uterine walls to preserve the uterus. Hysteroscopy was performed to evaluate the effect of UCS at 11 months postpartum, and eptal cord-like adhesions were observed in the center of the uterine fundus. Therefore, Asher-man’s syndrome was diagnosed. Since UCS can cause Asherman’s syndrome, careful postoperative follow-up is necessary. Outpatient rigid hysteroscopy is a minimally invasive and effective treatment for localized uterine adhesions. [Adv Obstet Gynecol, 75(3) : 255-261, 2023 (R5.8)]View full abstractDownload PDF (2141K) -
Yoshihiro KITAMURA, Yohei KISHI, Yui KITAOKA2023 Volume 75 Issue 3 Pages 262-268
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSAs uterine leiomyomas grow larger, they show various degenerative findings, making diagnosis difficult. We report a rare case of a huge degenerative broad ligamental uterine leiomyoma diagnosed preoperatively as an ovarian tumor, with a review of the literature. Our patient was a 43-year-old gravida three, para two woman with a 26-day menstruation cycle and no medical history or concomitant symptoms. She visited our hospital with a complaint of abdominal bloating that exacerbated a year ago and was suspected as an ovarian tumor on abdominal computed tomography. Thereafter, she was referred to our department. Abdominal examination revealed an elastic hard mass from the pubis to the hypochondrium. The results of blood test for ovarian carcinoma-specific markers revealed no abnormalities. Subsequently, based on a preoperative diagnosis of a left ovarian tumor suspected as a borderline malignancy or higher on pelvic magnetic resonance imaging, laparotomy was performed. Intraoperative findings revealed the ginat tumor beneath the broad ligament of the uterus. The resected tumor weighed 17 kg and was histopathologically diagnosed as degenerative leiomyoma. From this case, we propose that it is important to make ligamental uterine leiomyoma one of the differential diagnoses when a huge tumor is suspected in the pelvic cavity. [Adv Obstet Gynecol, 75(3) : 262-268, 2023 (R5.8)]View full abstractDownload PDF (2289K) -
Masaru KAWANISHI, Osamu TOKUYAMA, Madoka SURUGA, Makiko NAGATSUJI, ...2023 Volume 75 Issue 3 Pages 269-274
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSVon Willebrand disease (VWD) is a congenital coagulopathy caused by quantitative and qualitative abnormalities of von Willebrand factor (VWF), which leads to platelet dysfunction and hemorrhagic diathesis. There are several conditions that cause acquired VWF abnormalities and they are collectively called acquired von Willebrand syndrome (aVWS). In this case we report a patient who was 72 years old, had two pregnancies and two live births, and menopause at age 53. The patient had a history of meniscus injury, herpes zoster, and varicose veins in the lower extremities. The patient had a medical examination with a prior doctor earlier in the year due to irregular genital bleeding. The patient was then referred to our department with the diagnosis of endometrioid carcinoma G1. Preoperatively, the patient was diagnosed with stage IA uterine cancer and underwent robot-assisted total hysterectomy and bilateral salpingo-oophorectomy. No coagulation abnormalities were found in the preoperative examination, and intraoperative bleeding was small and hemostasis was not a problem. However, persistent bleeding from the wound and vaginal margins was observed after surgery, and the patient was referred to the hematology department. Upon examination, VWF was markedly low and aVWS was suspected. Since the patient had intermittent bleeding postoperatively, freeze-dried concentrated human blood coagulation factor VIII was administered and hemorrhagic diathesis improved. Since there was no history of hemostasis or hemorrhagic diathesis before this episode, aVWS was diagnosed. The postoperative diagnosis was stage IB uterine cancer, pT1bNXM0, endometrioid carcinoma G2. The patient underwent adjuvant chemotherapy and no recurrence has been observed. [Adv Obstet Gynecol, 75(3) : 269-274, 2023 (R5.8)]View full abstractDownload PDF (1370K) -
Hiroki KURAHASHI, Naoko KOMURA, Saya YAMASHITA, Asuka TANAKA, Kumi ...2023 Volume 75 Issue 3 Pages 275-283
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSThe incidence of ovarian malignant tumors during pregnancy is very low, ranging from 1/10,000 to 50,000 deliveries. We report a case of ovarian cancer during pregnancy that was detected at 36 weeks gestation. The patient was a 44-year-old gravida 0 who became pregnant by IVF-ET. She was referred to our center because of an elevated LD (904 IU/L) at 36 weeks gestation. Ultrasonography revealed a 13cm solid tumor in the right costal region, pleural effusion, ascites, and a mass in the fossa Douglas. Based on imaging findings, a malignant tumor of right ovary was suspected, and primary debulking surgery was performed along with elective cesarean section at 37+4 weeks of gestation. A 3100g baby boy was delivered with an Apgar score of 8/9. The right ovary was enlarged to 16 cm and an intraoperative frozen section diagnosed the tumor on the surface of the uterus as adenocarcinoma. Complete surgery was performed including the resection of peritoneal dissemination up to 3 cm. The diagnosis was endometrioid carcinoma of the right ovary, stage IIIC (pT3cNXM0) with HRD-test positive. She underwent six courses of docetaxel, carboplatin, and bevacizumab as adjuvant chemotherapy and was on maintenance therapy with bevacizumab and olaparib. [Adv Obstet Gynecol, 75(3) : 275-283, 2023 (R5.8)]View full abstractDownload PDF (5364K) -
Ryuichi IWATA, Hiromi YOKOTA, Sonomi KUROSE, Hiroki SASAMORI, Jyun ...2023 Volume 75 Issue 3 Pages 284-290
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSPolypoid endometriosis is a rare endometriosis that must be differentiated from malignancy on imaging and clinical course. We report a case of a large polypoid endometriosis that appeared to have originated from adenomyosis of the uterus. The patient was 53 years old, G2P2, and had undergone right adnexectomy at age 39 for a right ovarian endometriosis cyst. The patient came to our hospital with the chief complaint of a rapidly increasing right lower abdominal mass. On internal examination, a mass the size of a newborn baby’s head was found on the right side of the uterus with poor mobility with the uterus, and MRI showed an internal honeycomb-shaped mass contiguous with the myometrium, and a high CA125 level of 532.9 U/mL, which suggested the possibility of malignancy. In response, a total abdominal hysterectomy and left adnexectomy were performed. The pelvic cavity was frozen, probably due to endometriosis, and the tumor was continuous from the right posterior wall of the uterus and tightly adhered to the surrounding tissues. Histopathological examination of the excised specimen revealed that the glandular ducts and stroma of the mass were endometriosis-like glandular ducts and stroma, leading to the diagnosis of polypoid endometriosis. However, if the clinical course and imaging features of polypoid endometriosis can be identified and used as a differential diagnosis, excessive invasion can be avoided, and appropriate treatment can be selected. [Adv Obstet Gynecol, 75(3) : 284-290, 2023 (R5.8)]View full abstractDownload PDF (2028K) -
Airi KATO, Tomoko SUMIKURA, Hikari UNNO, Satoshi KUBOTA, Satoko M ...2023 Volume 75 Issue 3 Pages 291-300
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSParasitic myomas are a rare phenomenon, occurring when leiomyomas separate from the uterus and attach to other organs with feeding vessels. Many reported cases of iatrogenic Parasitic myomas are associated with power morcellator use during laparoscopic surgery. We report on a case of a Parasitic myoma resulting from laparoscopic surgery without power morcellation. A 47-year-old nulligravid woman presented with a history of genital bleeding. Magnetic resonance imaging revealed a 9-cm solid tumor consistent with a leiomyoma in the right pelvis, adjacent to a 3-cm thick-walled cyst, seemingly attached to the vaginal stump. She had undergone total laparoscopic hysterectomy for a leiomyoma four years prior. During this procedure, the uterus had been removed vaginally using hand morcellation. Laparotomy was performed, and two lesions were excised : one was confirmed to be a parasitic leiomyoma with feeding vessels originating from the ascending colon mesentery, and the other, a granulomatous cyst connected to the vaginal stump causing bloody vaginal discharge. Latrogenic Parasitic myomas are rarely reported without a history of power morcellation during open or endoscopic surgery. In-bag morcellation of the excised tissue and careful cleaning of the abdominal cavity should be considered during uterine surgery, even if power morcellation is not used. [Adv Obstet Gynecol, 75(3) : 291-300, 2023 (R5.8)]View full abstractDownload PDF (4780K) -
Akiko KAMIYA, Mirang KIM, Eriko TANAKA, Erina KIDO, Aya NAKAE, Re ...2023 Volume 75 Issue 3 Pages 301-307
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSThe prognosis for neonates with velamentous cord insertion is poor because the umbilical cord is easily compressed and umbilical blood vessels can be torn off with rupture of the membranes or fetal movement. We experienced a case of velamentous cord insertion in which an emergency cesarean section was performed while the membrane was not ruptured and the umbilical cord vessels were ruptured. The patient was a 28-year-old woman, gravida two, para one. There were no abnormalities during the pregnancy. At 40 weeks of gestation, NST showed a baseline heart rate of 180 beats/min, loss of heart rate variability, and late decelerations, leading to a diagnosis of non-reassuring fetal status. We performed an emergency cesarean section. We found a segmented placenta with a mangrove-like attachment of the umbilical cord to the placenta and a histopathological examination showed chorioamnionitis. The newborn was markedly anemic with a hemoglobin concentration of 7.8 g/dL, but early delivery and blood transfusion saved her life. By close inspection, we thought anemia was caused by umbilical cord vessel rapture. Based on progress of the disease and the placental findings, we suggested umbilical cord vessel rapture was caused by umbilical cord inflammation with thrombosis formed in the fragile vessel of velamentous cord insertion. [Adv Obstet Gynecol, 75(3) : 301- 307, 2023 (R5.8)]View full abstractDownload PDF (12449K) -
Yuki MATSUMURA, Mie TANAKA, Naoya SHIGETA, Yumiko KIYOHARA, Chifum ...2023 Volume 75 Issue 3 Pages 308-314
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSHyponatremia is one of the causes of oncology emergency that may require a rapid response. We present two cases of hyponatremia during AP chemotherapy for recurrent endometrial carcinoma. Case 1 : A 72-year-old woman with recurrent endometrial carcinoma (Stage IA) was treated with AP chemotherapy (DXR, CDDP). From the day after administration onwards, she suffered from nausea and vomiting, and thus her urine volume was significantly decreased. On the third day of administration, she developed impaired consciousness, and an examination revealed hyponatremia. Case 2 : A 69-year-old woman with recurrent endometrial carcinoma (Stage IVB) was treated with AP chemotherapy. On the third day of administration, she suffered from nausea, and on the fifth day she became unable to tolerate oral food intake. On the sixth day, a blood test revealed hyponatremia, which was considered to be the cause of the above symptoms. In both cases, we considered the cause to be the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Since there have been no previous reports of SIADH caused by DXR, we considered that CDDP was the cause. When chemotherapy involving CDDP is administered, it is necessary to anticipate the possibility of hyponatremia due to SIADH or other causes, and to detect and prevent it early. [Adv Obstet Gynecol, 75(3) : 308-314, 2023 (R5.8)]View full abstractDownload PDF (1716K) -
Rina KONISHI, Yoko NAGAYASU, Atsushi DAIMON, Misa NUNODE, Masami ...2023 Volume 75 Issue 3 Pages 315-321
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSThe World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic in 2020. Many cases of COVID-19 in pregnant women, with an increased risk of premature birth, stillbirth, and the development of preeclampsia have been reported. We report a case of COVID-19 and fetal growth restriction in a pregnancy complicated by antiphospholipid antibody syndrome (APS). A 35-year-old woman had a prenatal checkup at our university hospital. APS was diagnosed before pregnancy and treated with biaspirin, heparin, and prednisolone at 5 mg/day. She had cold symptoms around 31th week of pregnancy but did not report them. She had a good pregnancy course until 33th week of pregnancy. At this time, the COVID-19 infection was in full swing, so the next visit was three weeks later. On 35th week of pregnancy, her fetus was diagnosed with fetal growth restriction and oligohydramnios. We confirmed abnormal fetal heart rate pattern and decided to perform an emergency caesarean section. The preoperative SARS-CoV-2 antigen test result was negative. However, the patient tested positive for COVID-19 the next day. The baby weighed 1606 g and had Apgar scores of zero and two at one min and five min, respectively. The newborn tested negative for COVID-19. In this report, the association between COVID-19 infection and fetal growth restriction is unknown, but during a COVID-19 epidemic, patients tend to refrain from visiting hospitals because of the risk of infection ; high-risk pregnant women, such as those with APS complicated pregnancies, may need to be managed more strictly. [Adv Obstet Gynecol, 75(3) : 315-321, 2023 (R5.8)]View full abstractDownload PDF (2324K) -
Suzuka OKAJIMA, Makoto MURAKAMI, Rintaro ABE, Makiko NAGATSUJI, Mas ...2023 Volume 75 Issue 3 Pages 322-329
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSYolk sac tumors (YSTs) are malignant germ cell tumors that usually form in young women. We report a rare case of somatic YST with epithelial neoplasm in a 62-year-old postmenopausal patient. MRI and CT detected a multilocular cystic mass with an enhancing solid lesion in the right ovary and peritoneal dissemination. Preoperative serum tumor marker (CEA, CA-125 and AFP) concentrations were elevated. Debulking surgery was performed, but most of the lesions remained. In a pathological examination, the right ovarian tumor showed adenocarcinoma and YST components. The adenocarcinoma displayed columnar mucous atypical cells, and immunohistochemical staining was positive for alcian blue, and negative for SALL4, AFP, and glypican-3. The YST showed cuboidal atypical cells with a clear cytoplasm, and immunohistochemical staining was positive for SALL4, AFP, and glypican-3, and negative for napsin A. Postoperatively, the patient started BEP chemotherapy, and terminated it on the third day of the first course owing to her poor physical condition and renal dysfunction. She died on the 46th postoperative day because of rapid disease progression. Our findings suggest that postmenopausal women might have a YTS associated with an epithelial neoplasm, and this requires prompt diagnosis and treatment. [Adv Obstet Gynecol, 75(3) : 322-329, 2023 (R5.8)]View full abstractDownload PDF (3037K) -
Tomoko HIRABAYASHI, Yoko NAGAYASU, Atsushi DAIMON, Misa NUNODE, M ...2023 Volume 75 Issue 3 Pages 330-335
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSThe incidence of severe oligohydramnios in the second trimester is reported to be 0.5-5.5%. We report a case of a full-term infant born after amniotic fluid infusion for severe oligohydramnios. A 28-yearold woman underwent a previous prenatal checkup at another clinic. At 23 weeks and one day of pregnancy, she visited the clinic complaining of decreased fetal movement and was diagnosed with severe oligohydramnios. After informed consent, we performed an amniotic fluid infusion and umbilical cord blood flow resistance showed normalization. After that, the volume increase in amniotic fluid was subsequently maintained. At 25 weeks and zero days of pregnancy, fetal ascites appeared. Moreover, a fetal abdominal mass appeared at 26 weeks and two days of pregnancy. Due to the infant being in the breech position, an elective caesarean section was performed at 37 weeks and zero days gestation. The baby was born weighing 2257 g. Emergency laparotomy was performed on the same day and the baby was diagnosed with meconium peritonitis. The baby was discharged on the 16th day after the operation. In this case, we observed normalization of cord blood flow resistance with artificial amniotic fluid infusion, resulting in release of cord compression, improved cord blood flow, maintenance of fetal growth and amniotic fluid volume, and successful delivery of a full-term baby. [Adv Obstet Gynecol, 75(3) : 330-335, 2023 (R5.8)]View full abstractDownload PDF (1939K) -
Satoshi KUBOTA, Yoshihiro KURITANI, Hikari UNNO, Tomoko SUMIKURA, ...2023 Volume 75 Issue 3 Pages 336-343
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSUnilateral oophorectomy, a fertility-sparing surgery, is a suitable procedure for patients with ovarian borderline malignancies. However, in the case of recurrence in the remaining ovary, fertility preservation is challenging. Fertility preservation may be achieved by oocyte retrieval concomitant with contralateral salpingo-oophorectomy. We report a case of a 27-year-old unmarried nulligravida woman who had bilateral ovarian serous borderline malignancy stage IB (FIGO 2014) at 23 years old, treated with fertility-sparing surgery, including left salpingo-oophorectomy, right ovarian tumorectomy, and omentectomy. On examination, a recurrence in the remaining ovary was detected at 27 years old. We informed her about fertility preservation and decided to retrieve the oocyte concomitantly with right adnexa resection. Random-start controlled ovarian stimulation was scheduled for oocyte retrieval on the day of the surgery. After ultrasoundguided oocyte retrieval, the right adnexa with a recurrent tumor were resected with no signs of other diseases in the abdominal cavity. Seven mature oocytes were retrieved and cryopreserved. In contrast to transvaginal oocyte retrieval from a tumor-affected ovary, transabdominal oocyte retrieval combined with ovarian contact ultrasonography reduces the risk of tumor puncture and rupture. Childbearing patients who require castration for the treatment of ovarian tumors should be informed about oocyte retrieval and cryopreservation for their future fertility. [Adv Obstet Gynecol, 75(3) : 336-343, 2023 (R5.8)]View full abstractDownload PDF (2263K) -
Kota YAMAUCHI, Yukiyasu SATO, Yuka HOSOBE, Akimi YOSHIDA, Azusa S ...2023 Volume 75 Issue 3 Pages 344-351
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSHormone replacement therapy (HRT) is recommended for woman who have undergone bilateral oophorectomy before menopause to maintain their quality of life (QOL). On the other hand, HRT for woman with a history of endometriosis is reportedly related to its recurrence or malignant transformation. Case is a 49-year-old multiparous woman, who underwent abdominal bilateral salpingo-oophorectomy with hysterectomy for endometriotic cysts at the age of 43. Six years after the surgery, climacteric symptoms appeared and estrogen-only replacement therapy (ERT) was introduced after confirming the absence of detectable pelvic mass. Although the climacteric symptoms improved promptly, eight cm-sized irregular-shaped pelvic cyst containing multiple mural nodules emerged seven months after the ERT introduction. Positron D-glucose (18FDG) on the mural nodules, suggesting malignant transformation of the endometriosis-related tumor. Laparotomy was performed to resect the tumor. Since the tumor was firmly adherent to the surrounding organs, combined rectal resection was required to excise the tumor. Histopathologically, the tumor was diagnosed as endometriosis involving the entire rectal wall, without evidence of malignancy. In woman who have undergone bilateral oophorectomy before menopause, early postoperative introduction of HRT can lead to maintenance of their QOL. In woman with a history of endometriosis, especially those with advanced stage or residual tumors, combined estrogen-progestogen therapy (EPT) may be considered to minimize possibility of the endometriosis recurrence even after the hysterectomy. Since recurrence of endometriosis has been reported even during EPT, close follow-up is mandatory. [Adv Obstet Gynecol, 75(3) : 344-351, 2023 (R5.8)]View full abstractDownload PDF (3237K) -
Shuji MORISHIMA, Sachiyo SUGINO, Shohei TANABE, Kotaro ICHIDA, Ki ...2023 Volume 75 Issue 3 Pages 352-357
Published: August 02, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSVaginal stump dissection is a serious complication after total laparoscopic hysterectomy (TLH). A 40-year-old female patient came with complaints of menstrual dysmenorrhea. TLH was performed for a six cm uterine myoma. She had minimal bleeding during the first sexual intercourse on postoperative day 99, lower abdominal pain during the third sexual intercourse on postoperative day 106, followed by fever and yellow belts. There was a gap of about one finger on the right side of the vaginal stump and purulent fluid flowed out. When emergency laparoscopic surgery was performed, a large amount of pus-like ascites had accumulated in the abdominal cavity, and the small intestine was adherent to the vaginal stump. The vaginal stump was identified by inserting a finger into the abdominal cavity from the dissection. All vaginal stumps were opened while removing adhesions. The stump had become vulnerable due to infection and was re-sutured after removing the necrotic tissue. In this case, a slight injury to the vaginal stump occurs during the first intercourse, and bacterial infection develops from that site, leading to ascending peritonitis. It is speculated that the trigger was finally the dissection of the vaginal stump. It was suggested that early intervention may prevent vaginal stump development when symptoms such as bleeding occur after surgery. [Adv Obstet Gynecol, 75(3) : 352-357, 2023 (R5.8)]View full abstractDownload PDF (1683K) -
Seigo IBUCHI, Saiji IITO, Chika HIROTA , Ken UEKI2023 Volume 75 Issue 3 Pages 358-364
Published: August 02, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSUterine leiomyoma torsion is a relatively rare disease. It tends to occur before menopause, and a few studies report postmenopausal cases. Here, we describe two cases of postmenopausal uterine leiomyoma torsion that underwent laparoscopic surgery. Case one was a 60-year-old nulligravida. She was referred to our hospital because of lower abdominal pain and a mass identified by transabdominal ultrasonography. Magnetic resonance images showed a 10 cm subserosal uterine mass, and laparoscopic surgery was performed. The pedicle of the uterine mass was twisted at 720°. The pathological diagnosis was leiomyoma. Case two was a 70-year-old patient (gravida two, para two). She was referred to our hospital because of lower abdominal pain and uterine leiomyoma detected by abdominal ultrasonography. Magnetic resonance images showed a 6 cm subserosal uterine mass with no contrast effect within the tumor. The findings led to the diagnosis of torsion of a uterine mass, and emergency surgery was performed. A subserosal uterine mass was twisted 360° around the pedicle and showed necrotic changes. The pathological diagnosis was leiomyoma. Although rare, postmenopausal uterine leiomyoma torsion should be considered one of the differential diagnoses for acute abdomen in postmenopausal women. [Adv Obstet Gynecol, 75(3) : 358-364, 2023 (R.5.8)]View full abstractDownload PDF (2059K) -
Seiichiro NAO, Satoshi TSUNETOH, Yoko NAGAYASU, Daisuke FUJITA, Ka ...2023 Volume 75 Issue 3 Pages 365-371
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSSclerosing stromal tumor (SST) is a rare, benign ovarian neoplasm principally occurring in young women. SSTs are very rarely found in association with pregnancy. We report a case of a pregnant woman at 20 weeks of gestation who presented with a right ovarian tumor. Ultrasonography showed an eight cm solid mass with a rich blood flow inside it. The pulsatility index and the resistive index was low, thus a malignant tumor was suspected. A plain MRI showed a 70 mm mass originating in the right ovary. We judged an SST based on the abundant blood flow observed in the tumor by the above Doppler and MRI results. In order to get a definitive pathological diagnosis, we performed an operation. Since the possibility of a malignant tumor could not be ruled out, an abdominal right adnexectomy was carried out. We made the diagnosis of SST based on the pathological findings. Postoperatively, the patient continued with the pregnancy without complications, and she finally gave a healthy baby by vaginal delivery. If MRI or color Doppler examination reveals a blood vessel-rich mass, the possibility of SST should be kept in mind. [Adv Obstet Gynecol, 75(3) : 365-371, 2023 (R5.8)]View full abstractDownload PDF (1726K) -
Yumi NAKAO, Kanako MATSUYAMA, Yutaka UEDA, Akihiko YOSHIMURA, Shin ...2023 Volume 75 Issue 3 Pages 372-377
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSWe report a case of primary endometrial squamous cell carcinoma, which was suspected preoperatively. A 65year-old woman (gravida three, para zero), with a two-year history of postmenopausal genital bleeding was referred to our department, with suspected endometrial cancer. A two cm endometrial mass was detected on vaginal ultrasonogram. Both endometrial cytology and biopsy indicated a squamous cell carcinoma. Although the endometrial tumor was proximal to the internal uterine os, no obvious cervical lesion was found during speculum examination and on imaging studies. Considering the endometrial squamous cell carcinoma diagnosis, we performed semi-radical hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. The resected uterus showed a protruding lesion from the isthmus. Squamous cell carcinoma with keratinization, lacking adenocarcinomatous components, was diagnosed. There was no continuity between the carcinoma and cervical epithelium. Further, no other cervical lesion was noted.The final diagnosis was a squamous cell carcinoma of the uterine corpus, pT1a. HPV was not detected via immunohistochemistry. No additional postoperative treatment was needed. Furthermore, recurrence was not noted during 15 months follow-up period. Endometrial squamous cell carcinoma is a rare disease; therefore, it is necessary to gather more cases to establish or standardize its diagnosis and treatment. [Adv Obstet Gynecol, 75(3) :372-377, 2023 (R5.8)]View full abstractDownload PDF (2433K) -
Yumi NAKAO , Akihiko YOSHIMURA, Kanako MATSUYAMA, Takako MATSUKI, ...2023 Volume 75 Issue 3 Pages 378-383
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSAbdominal wall endometriosis is a rare form of endometriosis and occurs in 0.03-3.5 % of all cases of endometriosis. It usually develops in a surgical scar resulting from a cesarean section. We report a case of abdominal wall endometriosis at a site distant from the cesarean scar. The patient was a 32-year-old woman, with two pregnancies and two deliveries. She had a history of two cesarean section at 24 and 27 years of age. She had no dysmenorrhea and no history of endometriosis. She became aware of a mass on the right side below the navel and a cyclic local pain at the time of menstruation two years ago. She was referred to our hospital. The endometrioma was documented by ultrasound and MRI and we diagnosed abdominal wall endometriosis. She was treated with dienogest for six months, but her symptoms did not improve and she underwent excision of the mass. She was treated with dienogest for two years to prevent postoperative recurrence, she had no recurrence or complications. [Adv Obstet Gynecol, 75(3) : 378-383, 2023 (R.5.8)]View full abstractDownload PDF (2681K) -
Masumi SUNADA, Koji YAMANOI, Asuka OKUNOMIYA, Mana TAKI, Akihito ...2023 Volume 75 Issue 3 Pages 384-390
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSVaricella-zoster virus (VZV) infection is common, but rarely causes visceral disseminated VZV infection (VD-VZV), which can be lethal. Here we report a case of VD-VZV that developed during chemotherapy for choriocarcinoma. The patient was 46 years old. After seven courses of EMA/CO were ineffective, she was switched to four courses of EP/EMA. On admission for the 5th course, the patient complained of severe pericardial pain. On the 4th day of admission, blood and imaging tests showed elevated pancreatic enzymes and inflammatory swelling of the pancreatic head, and the diagnosis of idiopathic acute pancreatitis was made. Two days later, fever and blistering lesions appeared on the whole body. VZV has been confirmed and reactivated VD-VZV has been diagnosed. Acyclovir administration was started immediately. Her overall condition has gradually improved, and imaging and blood findings have also improved. On the 23rd day of admission, chemotherapy resumed. Her infection did not worsen, and acyclovir was terminated three days later. We continued chemotherapy for fourteen months, and no reactivation of VZV has been observed. The diagnosis of VD-VZV can be difficult because the initial symptom is characterized by abdominal pain without skin symptoms. When severe abdominal pain is present during long term chemotherapy, VD-VZV should be added to the differential diagnosis. [Adv Obstet Gynecol, 75(3) : 384-390, 2023 (R5.8)]View full abstractDownload PDF (2398K)
Clinical view
-
Fumitake ITO2023 Volume 75 Issue 3 Pages 391-395
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSDownload PDF (1281K)
Current topic
-
Kaori HAYASHI2023 Volume 75 Issue 3 Pages 396-397
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSDownload PDF (1164K)
Q&A
-
Ryuji KAWAGUCHI2023 Volume 75 Issue 3 Pages 398
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSDownload PDF (1150K) -
Miho EGAWA2023 Volume 75 Issue 3 Pages 399-400
Published: August 01, 2023
Released on J-STAGE: August 01, 2023
JOURNAL RESTRICTED ACCESSDownload PDF (1154K)
- |<
- <
- 1
- >
- >|